Provider Demographics
NPI:1336389063
Name:MUNIZ, JOSE R (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 OAKCLIFF RD.
Mailing Address - Street 2:APT149
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340
Mailing Address - Country:US
Mailing Address - Phone:770-234-0023
Mailing Address - Fax:
Practice Address - Street 1:3061 OAKCLIFF RD
Practice Address - Street 2:149
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340
Practice Address - Country:US
Practice Address - Phone:770-234-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN079003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse